What is your window to complete your q4h assessments?

umcRN, BSN, RN · Aug 2, 2012

I typically have 1-2 patients but in the NICU we could have up to 3.

With two patients I usually start the "less involved" one at 0745 - less involved being if I have an infant and a toddler or older child, the infant is going to be less involved (usually), (of course if one patient is more critical and needs sooner assessment I start with that one) I finish up with them around 0800-0810 then start the next kiddo until about 0830, then I chart.

This can be interrupted by rounds depending on where in the unit they start, parents who might need some more attention, a kiddo that wont stop crying or is having issues that need to be addressed - sedation needs, vomiting, desats etc.

This is my ideal schedule but it rarely sticks, before I touch anyone I write out a list of my "to-do's" for both patients, meds, tasks, feedings, etc so I can stay on target that way as well.

Then if anyone is PO feeding well they usually get their own schedule, especially babies who are fed on the three's (0900, 1200, 1500, 1800...) then their care/assessments are clustered to when they have to eat.

um hamed · Aug 2, 2012

In our hospital we used to have 1-1 but some times we are getting when the situation become difficulty managed.

in this situation my collages are helping me &that reduces the tension of work to some instance.

Piglet08 · Aug 3, 2012

Whenever I can. If I predict I'm gonna be slammed at that 4 hr mark, I'll do it early. Sometiimes late, uf'ly. And sometimes I am so busy with actual patient care that charting my final assessments is but a dream until after I've given report. ( I've seen some other nurses have to do that more often. However, those are usually the anal charters. I may someday get scolded for undercharting, but until then, I'm not going to chart every single hour that the patient is on a ventilator. I chart that at the start of the shift, and if that changes, I'll chart the change. I will chart lung sounds, skin assessments, stuff like that, but not unchanging equipment.)

Ideally, 8 -12 - 4. Real life, maybe 7:30, 11 and 3. Ish. If I was busy with a crisis in bed 2 at 12, I don't want it to look like I'm trying to pretend I was at bed 1's bedside at that time, so my times WILL be off.

lawandaluxnurse, ADN, BSN · Aug 3, 2012

I do them as close as I can but in reality you can do 15 minutes or 30 minutes prior or after it depends on how many patients and the acuity.

detroitdano · Aug 3, 2012

We have max two patients, and work 7-7. I do one patient's assessment during the 7 o'clock hour, then the other's during the 8 o'clock hour. I'll usually take my 9 o'clock meds with me for my 8 o'clock assessment, then I can knock out both. Hell, if it's a good night I might even draw labs before 9 while I'm in there too. Or if I'm feeling like super nurse, I might do the bath! Someone stop me I've gone mad!

It's a good system. Your second/third assessments aren't usually as involved if they're stable, so I'll check someone out at 11 and have squat to do until 12 which is nice.

Management doesn't care when you do them. If someone did one at 3 and I don't get one in until 8 for that patient, it's fine, as long as my pain/restraint charting is done within our time windows.

gonzo1, ASN, RN · Aug 4, 2012

I work 7p-7a. I take report, then pop in and say hi and introduce myself to each pt. ICU, we have2, maybe 3. This is to make sure that both are breathing, on the monitor etc. Then I usually start with assessment on whichever one I think is the most likely to die on me tonight.

I take paper notes while assessing them and put the report in the computer later. After I am done with the sickest I then go in to the lessor sick one and do my assessment on them.

The important thing to remember is that you shouldn't just be doing an assessment at 7, 11 and 4. Everytime you walk in the room and interact with the pt is an assessment chance. Look at their speech, their color, their vitals on the monitor. If you go in at 10, listen to their lungs then. There shouldn't really be much change when 11 rolls around. So you've already done your assessment.

If you are continually assessing your pts with each contact then you already have your assessement for the most part done when charting time comes.

OnlybyHisgraceRN, ASN, RN · Aug 4, 2012

I work 7p-7a. I take report, then pop in and say hi and introduce myself to each pt. ICU, we have2, maybe 3. This is to make sure that both are breathing, on the monitor etc. Then I usually start with assessment on whichever one I think is the most likely to die on me tonight.
I take paper notes while assessing them and put the report in the computer later. After I am done with the sickest I then go in to the lessor sick one and do my assessment on them.
The important thing to remember is that you shouldn't just be doing an assessment at 7, 11 and 4. Everytime you walk in the room and interact with the pt is an assessment chance. Look at their speech, their color, their vitals on the monitor. If you go in at 10, listen to their lungs then. There shouldn't really be much change when 11 rolls around. So you've already done your assessment.
If you are continually assessing your pts with each contact then you already have your assessement for the most part done when charting time comes.

Great point of view. I always provide ongoing assessments but I guess I'm trying to be so perfect that I feel like I have to constantly re-assess for 7,11, and 3. Gosh, I have so much to learn.

EyeSeeYuRN · Sep 4, 2012

Working night shift adds another whole level of needed creativity, especially if your patients is a walker/talker. See lab duck in the room at 0315? You betcha I'm grabbing any necessary equipment and getting some assessments/checks done. X-ray sits the patient up? Great time to get a good listen to those lung sounds from the back. We don't have any official parameters for when we have to do our assessments (yes, we do 2000, 0000, and 0400) but as far as time frames to do them in, we use our best judgement. Which, all of you have so accurately delineated above.